It’s 2018. Social media is chock full of cringeworthy niche communities, from slime connoisseurs to those who watch videos of earwax removal for pleasure. Plentiful as they may be, they’re all just grains of sand. Meanwhile, dermatologist Sandra Lee, better known as Dr. Pimple Popper, runs the entire Weird Internet Beach.

Lee’s YouTube channel and Instagram account are responsible for bringing “extraction videos,” clips of bursting cysts and blackhead removals, into the mainstream. Today, @drpimplepopper boasts over 2.8 million followers and Lee’s YouTube videos have amassed more than 3 billion views. She’s begun to move beyond blemish-squeezing to the entrepreneurial realm with ventures like her own skincare line and a TV show. A book and board game, appropriately named Pimple Pete, are also in the works.

V spoke with Lee about her entrance into the world of pimple-popping, the lengths fans will go to have their skin prodded, and the greater purpose behind her brand. Our conversation confirmed what everyone already knew: It’s Dr. Pimple Popper’s world. Popaholics or not, we’re all just living in it.

How did your career as a dermatologist and surgeon bring you to pimple-popping?

I know, isn’t that the question that everybody asks? [Laughs] Me, too. I ask that, too. It happened about three and a half years ago, four years ago. I started the Instagram page because I thought people might be interested in my world. It’s a very visual field, you know, and Instagram is very visual. It lends itself well. Early on, I posted a blackhead extraction video and it got a noticeable increase in attention. I thought, "That’s really weird, let me do it again." And I did it again, and it happened again. From there, I discovered there was a world on the Internet of people who were obsessed with pimple-popping videos! I had no idea. So, I decided I could be their queen…I didn’t know that this pimple sort of thing existed. It was sort of like a little, quiet subculture, but I feel like we’ve sort of helped to bring it out of the closet and have it be accessible. People understand it and they embrace it. They don’t mind the fact that they like to watch this stuff. I think it makes people happy and that’s, for me, why it’s sustained itself for so long and how it continues to grow. Ultimately, it makes people happy and that’s it. That’s what’s so crazy about it.

Before your Instagram and YouTube page blew up, was it awkward to ask people if you could film their procedures?

Actually, no, it wasn’t. I think it has to do with, maybe, my delivery and my personality with my patients. I’m really friendly and I develop relationships with my patients, and I think what happened is, I actually feel like this is something that my patients wanted all along, but a lot of them never didn’t bring it up to me, or I would, in the past, like any other dermatologist, say, "Oh, yeah, that’s a blackhead, don’t worry about it. I won’t do anything because it’s not medically necessary." And now, what I’ll say is, "Would you mind if I took a video of me removing this milia and posted it and no one will know who you are because it’s anonymous?". Everybody says sure. Even now, four years later, I have had people say no, probably, I can count on one hand. People come from far now to do it. They’re actually let down if I decide not to post something or not to videotape something. So it’s just a win-win-win because I realized, then, that the patients that have the biggest blackheads are usually my older patients, and they’re the ones that can’t see really well, but they don’t actually even know what this is. They feel ugly because they feel the bumps, but they don’t know how to take care of it. They’re actually really thankful that I’m doing something for them.

Where is the furthest people have come from to have their pimples popped by you?

I’ve had people come from Africa.

No way.

Yes! I’ve had people, probably, from all continents. I’ve had people come from Australia. I’ve definitely had people come from London, Canada, and I had one person come from Iowa. She took a plane to Las Vegas with a layover, she rented a car and drove it to my office. It was ridiculous. I mean, it’s pimple-popping! How crazy is that? It’s crazy. It shows you the power of social media, you know?

Absolutely. Growing up, I was always told by my dermatologist that popping pimples is the worst thing you can do for them. What’s your stance on that?

I’m gonna agree with your dermatologist. He or she is a smart person. That’s exactly what I’m gonna say, too. The issue, or the reality, is that people are not going to be able to keep their hands to themselves, myself included, so I’m kind of more on the line of don’t pop it, but if you do, let me try to at least tell you how — just like my videos. They’re meant to entertain, but they really are meant to educate. If I can teach you why you shouldn’t pop that pimple or how you should do it, you’re probably going to take better care of your skin in the long run.

Right. You’re going to do it, so you may as well do it in the best possible way.

Yeah, or understand why you shouldn’t do it when it’s in this setting because of what could happen. I always tell people: Know when to pop, know when to stop. Definitely, if you’re gonna try to pop a pimple, if you have issues with keeping your hands to yourself, you can set a timer, like a pimple-popping timer countdown or something. You know, you don’t want to squeeze too much because it might not be something you can pop in the first place. Also, the deeper something is under your skin, the more you have a chance of permanently scarring the area. That’s what the game is for, too. If you really have an urge, even in the office, you can take that in the corner with you.

Yes. I mean, in general, but it all depends. It’s complicated. It depends on your insurance, you know, certain insurance is going to cover it…and a lot of people don’t have insurance. Remember, the difference is that these are not medically necessary procedures. Even if you hate the look of them or you’ve got, like, a football-shaped lipoma behind your head, if that’s not actually going to threaten your life, some people argue, why are you going to remove it? Sometimes people say, "OK, if you’re going to remove it, it’s gonna cost you 20 thousand dollars to do that." I mean, because if you’re going under general anesthesia or all of those different things, the money adds up. With any of these things, if it’s not life-threatening, there’s a chance that it’s not covered by insurance. I think, you know, acne treatment is for the most part, but even, like, it’s called acne surgery when you do extractions, that is not covered by all insurances.

At that point, are people willing to pay out of pocket?

Well, what I usually do is I give them a discount — sometimes it’s free — for me to do their treatment if they allow me to videotape it. That’s really been nice because it’s I feel like it’s a win-win-win for everybody. Obviously, they get to have this removed, then I get to videotape it and grow social media, and people who love to watch it can watch it.

Do you have a whole social media team now?

I do [laughs]. I’m actually in our Culver City office right now and we’ve got our whole popaholic bunch here and it’s just growing. And really, what this whole thing was for, why was I trying to grow this pimple-popping business, one part of it was because I wanted to see if I could do it. I know it’s not easy to build social media and become an influencer. The other part was really to use it to sort of educate people and create this skincare line, SLMD. It’s a line that I’ve been wanting to create, it’s sort of a medical line that provides treatment options for people who cannot get to a dermatologist. Or people who can, and they don’t really even know what they have, they don’t know what to use. So I’m trying to give things to people that I myself would recommend as a dermatologist and for people to understand why those treatment options work. If they understand why, it kind of makes them more compliant. It makes you want to use it. And also, it gives you control. You know, if you’re getting something and someone’s telling you, "Use this," and it works for you, if you understand why it worked, you’re gonna be more likely to use it.

How has filming your show for TLC differed from posting your own videos on Instagram?

Oh, it’s really different. It’s very grueling. It’s really stressful, honestly, because it’s not under my control. I mean, it is in some senses, but these are people with really big, traumatic conditions and they’re flying in — we just had someone, last week, fly in from the Philippines for it. And so for me to meet them for the first time and potentially do something to treat them, I mean, that’s a lot of responsibility and there’s three cameras watching you. I feel a lot of responsibility because my number one thing is to make sure the patient is OK. That’s number one in my line. I’m not doing something because it’s just for the camera. I’m doing this because I’m trying to help them and show people what a board-certified dermatologist can do. Some people think we are just pimple-poppers, but we’re so much more than that! It’s also been really nice, with the TV show, for this to be out of my hands, out of my control, because it’s really shown me — I think it makes me look better than I am. It shows me how I actually have changed people’s lives. You don’t realize how much this impacts people. I don’t see people afterwards, I don’t see them interact with their families after they’ve been treated, so it’s really nice for me to see. And I feel like I’m so pleased with how people are responding to it. I think we’re really turning a lot of people into popaholics, people that were grossed out by it before. I think they’re really understanding what this is all about now.

What do you hope viewers gain from your work?

I mean, I just want them to understand these conditions and understand that these are real people that have these conditions, like you and I, who might be walking around and hiding things under our clothes — some of us can’t hide them because they’re on our face — and understand that and be more kind to one another, I suppose. And understand what these conditions are, learn about it, too. I think that that’s mainly it. It’s really to show people what we do as dermatologists. We’re not one step above the Clinique counter. We’re real physicians that do some interesting things and help people, which is nice.